Global Consensus Recommendations for Metabolic Dysfunction-Associated Steatotic Liver Disease and Steatohepatitis.
Summary
This Delphi-based global consensus harmonizes MASLD/MASH care across 61 recent guidelines, delivering highly agreed statements (>90% agreement) and practical algorithms spanning screening, fibrosis assessment, and therapy in the era of resmetirom. It emphasizes mandatory screening in T2D, noninvasive fibrosis stratification (e.g., FIB-4, VCTE), and surveillance in advanced fibrosis.
Key Findings
- Comprehensive synthesis of 61 guidelines produced consensus statements with >90% agreement via four-round Delphi.
- Mandatory MASLD screening and noninvasive fibrosis assessment recommended in high-risk populations, notably T2D.
- Guidance updated for the resmetirom era, with algorithms for diagnosis, risk stratification, and surveillance.
Clinical Implications
Adopt routine MASLD screening in T2D, apply FIB-4 and VCTE-based pathways for fibrosis risk, consider resmetirom for appropriate MASH phenotypes, and implement HCC surveillance in advanced fibrosis/cirrhosis. Multidisciplinary metabolic care and weight loss interventions remain foundational.
Why It Matters
Provides unified, timely guidance for a highly prevalent metabolic liver disease tightly linked to T2D, likely to standardize care and inform policy and payer decisions worldwide.
Limitations
- Consensus relies on underlying heterogeneous guideline evidence quality.
- Guideline recommendations may require regional adaptation and future updates as new trials report.
Future Directions
Prospective validation of algorithms in diverse health systems, integration with T2D care pathways, and real-world effectiveness of resmetirom-inclusive strategies.
Study Information
- Study Type
- Systematic Review
- Research Domain
- Diagnosis
- Evidence Level
- IV - Consensus synthesis of existing guidelines and evidence using Delphi methodology.
- Study Design
- OTHER